How long would you like to wait for your Occlusion MI to show a STEMI? Sometimes serial ECGs minimizes the delay.

Written by Pendell MeyersAn elderly woman presented with acute onset chest pain and shortness of breath. EMS showed us their ECG on arrival at her house:What do you think?There is sinus rhythm with minimal STE in V1-V3, not meeting STEMI criteria. However, this STE is definitively abnormal in the setting of a normal QRS complex and hyperacute T-wave morphology in V2. There is a small amount of reciprocal STD in V6 with a negative T-wave.This is subtle but diagnostic for anterior Occlusion MI. V2 never has this appearance in the absence of full thickness ischemia.We called for emergent cath lab activation.The cardiologist arrived quickly and was skeptical about these findings on EMS ECG. So while they were trying to explain their interpretation I simply recorded another ECG:This ended the discussion.100% mid-LAD occlusion.LAD now open after intervention.Peak troponin T was 1.76 ng/mL.Repeat ECGs after intervention were consistent with successful reperfusion without significant Q-wave development:Convalescent echo showed EF 41% with anterior, lateral, and apical wall motion abnormalities. Given the relatively rapid reperfusion, and the absence of QS-waves, much of the abnormality on echo could be reversible (myocardial stunning, not infarction). Learning Points:Serial ECGs can sometimes turn a difficult decision into a very easy one, but not all OMIs will develop into clear STEMIs quickly, and some OMIs never will manifest STEMI at all. The delay between OMI and ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs